Lissy F. Jarvik

Cognitive-Behavioral and Psychodynamic Group Psychotherapy in Treatment of Geriatric Depression

The purpose of the study was to assess whether depressed geriatric patients would respond to group psychotherapy and, if so, would they respond differently to cognitive-behavioral and psychodynamic group psychotherapy. Thirty-three persons entered the study and 20 completed the 9-month course of treatment. Patients in both types of groups showed statistically and clinically significant reductions on observer-rated measures of depression and anxiety, as well as on self-report measures of depression. There were no clinically significant differences, but a statistically significant difference between the types of groups was found for the Beck Depression Inventory and this favored the cognitive-behavioral treatment. Limitations on interpretation of these results because of the lack of a control condition are discussed. Approximately 7% to 11% of the American population age 65 and older suffer from depression (Gurland, 1976), making the treatment of depression in the elderly an important concern of both research and practice. Yet, few psychologists (Dorken & Webb, 1979) or psychiatrists (Marmor, 1975) in private practice see elderly patients, and the preferred mode of treatment for this age group appears to be pharmacological (Ford & Sbordone, 1980). However, the use of antidepressants may be contraindicat ed for a large number of el

Antidepressant drug studies, 1964 to 1986: empirical evidence for aging patients

This review is based on 25 double-blind anti-depressant drug studies reported between 1964 and 1986 that focused on patients over 55 years of age. The number of studies located in the literature is appallingly small, particularly when we consider that we included experimental drugs as well as drugs not recommended for use with the elderly. In general, the results of our survey support clinical experience: the drugs are clearly superior to placebo; they show comparable therapeutic efficacy--about 50% improvement in Hamilton Psychiatric Rating Scale for Depression scores versus 20% to 25% on placebo; and all of them have undesirable side effects. Thus, the choice of drug is based on side effects profiles and potential drug-drug interactions rather than on degree of therapeutic efficacy. The review makes apparent the need for more substantial data on treatment outcome in patients over the age of 60 years. Beyond that, additional information is unlikely to change the 50% response rate or the potential for serious side effects with most of the currently available drugs. We clearly need better drugs.

Cognitive function and prediction of dementia in old age.

Longitudinal changes in cognitive functioning were examined for a sample of aging twins, some of whom developed dementia while others did not. Individuals who were judged to be demented at a mean age of eighty-five years had achieved lower scores on most tests twenty years prior to diagnosis, and experienced greater declines in vocabulary and forward digit span over time, than those surviving to a comparable age without dementia. These trends were observed for individuals with mild, as well as moderate-to-severe, dementia and were unrelated to physical health status or premorbid activity patterns. It is suggested that dementing illness may develop very slowly, and that the likelihood of exhibiting clinically significant dementia may vary with premorbid intellectual level.

Sex differences in cognitive functioning: Evidence, determinants, implications.

The purpose of this article is to examine the evidence for sex differences in cognitive functioning and to review and evaluate evidence for hormonal, genetic, neuro-anatomical, and cultural determinants of such differences. Inadequacies in the evidence for sex differences, such as underreporting of negative findings, failure to measure effect size, small sample sizes, etc., are noted. It is likely that sex hormones influence the organization and functioning of the brain. Sex differences in brain organization and functioning are discussed. In summary, the existence of sex differences in cognitive functioning is clear, but further research is needed to elucidate the determinants of these differences.

Cognitive-behavioral treatment of older veterans with substance abuse problems.

The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the programs services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.

Intellectual performance of octogenarians as a function of education and initial ability.

A 20-year follow-up of 54 octogenarians, tested originally at a mean age of 64 years, revealed that the initially more able (estimated by vocabulary score) declined less on tests in a cognitive battery than did the initially less able. When classification was based on level of education rather than initial ability, the better educated showed the lesser decline. It is postulated that continuedintellectual activity throughout the life span may protect against intellectual decline.

Philothermal response of polymorphonuclear leukocytes in dementia of the Alzheimer type.

The philothermal response, i.e., the tendency of polymorphonuclear leukocytes (PMNs) to migrate along a temperature gradient toward warmer temperatures, was evaluated in 11 patients with a clinical diagnosis of dementia of the Alzheimer type (DAT) and compared to 11 age and sex-matched mentally normal individuals. While the total number of migrating PMNs did not differ significantly between these two groups, there was a significant difference in the spatial distribution of the responding cell population. The numerical parameter, R, has been introduced to provide a quantitative measure of the distribution of populations characterized by differences in motile behavior. This R value was unusually high for 10 of the DAT patients but only one of the comparison individuals. No relation between R and duration of illness, age, or sex was detected. These preliminary findings, based on a small number of clinically diagnosed DAT patients, suggest that the philothermal response may represent a biological marker with diagnostic usefulness for at least one subgroup of DAT patients.

UPBEAT: the impact of a psychogeriatric intervention in VA medical centers. Unified Psychogeriatric Biopsychosocial Evaluation and Treatment.

Background.The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. Objectives.To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. Design.Randomized trial. Subjects.Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). Measures.The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. Results.Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by

Potential ethnic modifiers in the assessment and treatment of Alzheimer's disease: challenges for the future

1,171 (P <0.001) per patient, but lowered inpatient costs by

Cognitive performance in relatives of patients with probable Alzheimer disease : an age at onset effect ?

3,027 (P = 0.017), for an overall savings of